MEDICARE: PEAK EYE CARE, SC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1528829405
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEAK EYE CARE, SC

Provider Business Mailing Address
First Line	:	3670 S 108TH ST STE 204
Second Line	:
City	:	GREENFIELD
State	:	WI
Zip	:	53228-1237
Country	:	US
Telephone Number	:	414-452-1010
Fax Number	:	414-425-4250

Provider Business Practice Location Address
First Line	:	3670 S 108TH ST STE 204
Second Line	:
City	:	GREENFIELD
State	:	WI
Zip	:	53228-1237
Country	:	US
Telephone Number	:	414-452-1010
Fax Number	:	414-425-4250

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	DR. MARK ALLEN DAGENAIS
Credential	:	OD
Telephone Number	:	262-490-8000

Provider Enumeration Date	:	01/18/2024
Last Update Date	:	01/18/2024

Similar Medicare Providers

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Practice Location Address:

3670 S 108TH ST , STE 204
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53228-1237

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1487213237 — AURORA PHARMACY, INC
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Directions to “PEAK EYE CARE, SC ” Practice Location

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